Where Clinician Expectations and Workplace Realities Are Diverging

A new survey reveals the factors that are driving clinicians toward the exit, pushing hospital leaders to rethink how they support and retain their workforce.

Clinicians are increasingly dissatisfied with their working conditions, with many questioning whether they can stay in the profession as staffing shortages and burnout persist, a new workforce report shows.

Vivian Health’s survey of 471 clinicians points to a widening gap between what workers expect and what they experience on the job, highlighting the need for hospital leaders to rethink their retention strategies.

Eighty-four percent of respondents said their units are facing staffing challenges, and more than half (53%) described their units as not adequately staffed. Forty-three percent reported being denied paid time off because of short staffing.

The disconnect is also affecting hiring and retention. One in five clinicians said they ended a contract early because the role didn’t match what was advertised, while 10% withdrew before their start date for the same reason. Safety concerns were the top driver as 31% ended contracts early due to unsafe or toxic work environments, while 42% backed out before starting after learning about safety issues.

Burnout remains widespread. Seventy-six percent of clinicians said burnout is unchanged or worse compared to last year. Nearly half (43%) rated their current job satisfaction at five or below on a 10-point scale, and two-thirds (66%) reported having considered leaving healthcare altogether.

The report reveals several contributing factors behind clinicians’ dissatisfaction, including misaligned job expectations, a lack of schedule flexibility, limited access to PTO, and unsafe working conditions. Respondents also reported increased concerns about patient care quality, medical errors, dissolving of public trust, and mental health impacts tied to current workloads.

How CEOs Can Respond

For hospital CEOs, the report calls attention to the need to realign workforce strategy with the realities clinicians face.

Greater transparency around job roles and working conditions can help reduce early contract terminations and prevent new hires from backing out before their start date.

The findings also point to the importance of strengthening staffing models so that units are adequately resourced, which in turn can ease burnout and reduce the frequency of denied PTO.

Leaders may need to rethink how they provide schedule flexibility, how quickly they respond to reports of unsafe conditions, and how they address burnout as a structural issue rather than relying on wellness initiatives alone.

Ensuring clinicians have clear channels to raise concerns, and acting on those concerns, can help rebuild trust.

By focusing on creating more transparency and alignment, hospital leaders can move closer to meeting clinician expectations and strengthen their ability to retain staff.